Can you tell us a little bit about how your team conceived of this intervention? Like, how did you get interested in tackling this particular deprescribing target? And how did you think about which intervention components to focus on?

Yeah, thanks for that question.

So I should say that my team came in after the intervention actually took place to evaluate it.

But I think I can speak a bit for the pharmacists who really developed this and rolled it out.

So in the VA health system, many medical centers use what's called the DOAC dashboard, the Direct Oral Anticoagulant Dashboard.

proactively allows monitoring for the appropriate indication for each drug, things like appropriate renal dosing.

And there's been interest in expanding the limits of what they're calling an antithrombotic stewardship approach.

So can you just describe like the different pieces? There were two phases and just tell us a little bit about what the team actually did.

Can you tell us a little bit about how your team conceived of this intervention? Like, how did you get interested in tackling this particular de-prescribing target? And how did you think about which intervention components to focus on?

Yeah, thanks for the question.

So I should say that my team came in after the intervention actually took place to evaluate it, but I think I can speak a bit for the pharmacists who really developed this and rolled it out.

So in the VA health system, many medical centers use what's called the DOAC dashboard.

The direct oral anticoagulant dashboard proactively allows monitoring for the appropriate indication for each drug, things like appropriate renal dosing, and there's been interest in expanding the limits of what they're calling an antithrombotic stewardship approach.

And as there's been this accumulating body of evidence that combination antithrombotic therapy, by which I mean use of both an antiplatelet drug and an anticoagulant, the growing body of evidence that this is actually probably harmful for the majority of patients who are prescribed the combination.

And so they were thinking a lot about ways to push the boundary, and so they formed an anticoagulation work group within their VISN, which is a regional network of VA medical centers, in this case, seven medical centers, to come up with an implementation approach.

So can you just describe, like, the different pieces? There were two phases, and just tell us a little bit about what the team actually did.